Provider Demographics
NPI:1497343503
Name:SIBREY, JAIMMIE WENDOLYNE (CPHT)
Entity Type:Individual
Prefix:MS
First Name:JAIMMIE
Middle Name:WENDOLYNE
Last Name:SIBREY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 SE 12TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-8104
Mailing Address - Country:US
Mailing Address - Phone:352-871-8904
Mailing Address - Fax:
Practice Address - Street 1:842 SE 12TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-8104
Practice Address - Country:US
Practice Address - Phone:352-871-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 183700000X
FLRPT25778183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No174H00000XOther Service ProvidersHealth Educator